AB1136 PREVALENCE OF COVID-19 IN SYSTEMIC LUPUS ERYTHEMATOSUS: A META-ANALYSIS
Authors: J. Wang, S. X. Zhang, X. Y. Yin, B. R. Zhao, Y. R. Shi, J. Y. Meng, Q. Y. Su, X. F. LI, C. Wang
Journal: Annals of the Rheumatic Diseases (2022)

Background Novel Coronavirus pneumonia 2019 (COVID-19) is a systemic infectious disease with prominent involvement of the respiratory tract, due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [1] . Systemic lupus erythematosus is charcterized by an aberrant immune response with the presence of circulating autoantibodies, lymphopenia, and proinflammatory [2] . They are immune-compromised and vulnerable to infections with immune-suppressants treatment. However, data regarding the impact of COVID-19 pandemic in patients with SLE and drug use were relatively scarce. Objectives The prevalence of COVID-19 in SLE patients was estimated by means of meta-analysis, and the effect of the use of anti-rheumatic drugs on the clinical outcome of SLE patients with COVID-19 was investigated. Methods Cross-sectional investigations and case series on SLE and COVID-19 published by CBM, CNKI, China Science and Technology Journal Database, Wan Fang Data, PubMed, Embase, Web of Science, Cochrane Library and Medline from its establishment to November 10, 2021 were searched. Random effects model was used to pool data. Heterogeneity and risk of bias was examined with I-squared index (I 2 ) statistic. Inconsistency was evaluated by using the I 2 . Egger tests were used for the evaluation of potential publication bias (STATA v.12.0). Results A total of 14 studies comprising 5365 patients were identified (Table 1). Overall prevalence of COVID-19 in SLE patients was 1.5% (95%CI: 1.2%-1.8%). Eight of the studies included patients who used hydroxychloroquine as part of their treatment regimen, with 29.8% (95%CI: 25.8%-33.8%) hospitalization rates and 14.6% (95%CI: 11.5%-17.8%) adverse outcome rates. Among patients treated with hydroxychloroquine throughout the course of disease, the prevalence was 0.7% (95%CI: 0.4%-1.0%, Figure 1). Table 1. Summary of study characteristics of included records. Author Total number of patients Mean/Median Age HCQ Other therapeutic drugs Number of COVID19(n) Mean/Median Age HCQ Other therapeutic drugs Hospitalization(n) supplemental oxyge(n) Combined poor outcomes Gerard Espinosa 400 50.7 GCs:47 4 47.9 22 GCs:12,T-DMARD:28,others:13 3 3 4 Emanuele Bozzalla Cassione 165 52.5 127 T-DMARD:12,others:41 12 52.5 3 GCs:1,others:3 1 Ren: Cordtz 2533 55.4 1170 GCs:685,B-DMARD:42,T-DMARD:374,others:926 16 69.1 5 GCs:4 16 Ruth Fernandez-Ruiz 226 83 43 32 GCs:18,T-DMARD:5,others:50 24 19 8 Zos Gendebien 225 51.7 152 GCs:92,T-DMARD:25,others:52 32 2 2 Wendy Wan Hui Lee 85 38.28 58 GCs:54,others:50 23 1 1 Giuseppe A. Ramirez, MD 417 others:389,combination:289 14 1 1 Samar Tharwat 200 30.1 140 GCs:174,B-DMARD:4,T-DMARD:310,others:184 32 Dina Zucchi 332 47 267 GCs:176,B-DMARD:41,T-DMARD:118,others:118,combination:112 6 40.3 6 GCs:6,T-DMARD:1,others:6 3 1 1 Sarthak Gupta 17 7 GCs:8 17 46.1 1 GCs:12,T-DMARD:3 10 2 2 Seow Lin Chuah 18 18 38uah 6 7 Claudia Diniz Lopes Marques 110 334 45 (31ques 118 GCs:134,T-DMARD:110,others:284 110 35 78 Beth Wallace 31 61 6 GCs:12,others:4 5 54 (26-67) 4 GCs:4,others:3 5 5 Isabela Maria Bertoglio 382 45.1 382 45.5 206 173 Figure 1. A:Forest map of a meta-analysis of COVID-19 prevalence in SLE patients.B: Forest map of a meta-analysis of hospitalization rates among patients treated with hydroxychloroquine.C:Forest map of meta-analysis of the rate of adverse outcomes in patients using hydroxychloroquine as part of a treatment regimen.D:Forest map of a meta-analysis of the prevalence of patients treated with hydroxychloroquine throughout the course. Conclusion Patients with SLE had a higher risk of COVID-19. Hydroxychloroquine might benefit to reduce the overall hospitalization rate and prevalence rate of COVID-19, and alleviate inflammatory damage in the chronic stage of viral infection by inhibiting over activation of the immune system. References [1]SCHULTZE J L, ASCHENBRENNER A C. COVID-19 and the human innate immune system [J]. Cell, 2021, 184(7): 1671-92. [2]KIRIAKIDOU M, CHING C L. Systemic Lupus Erythematosus [J]. Ann Intern Med, 2020, 172(11): Itc81-itc96. Acknowledgements This work was supported by the National Natural Science Foundation of China (No. 82001740). Disclosure of Interests None declared